Ruminations by a non-academic general surgeon from the heart of the rust belt.

Sunday, June 8, 2008

Physician owned and operated

One response physicians have had over the years to the battle over dwindling reimbursements has been to seize the reins of health care delivery themselves, by building physician owned and operated hospitals and/or surgicenters. By controlling the means of health care delivery, doctors regain a certain sense of autonomy in an era where big government in America desperately tries to neuter our political voice. After all, aren't we just "providers"?

Recently, I was approached by group looking to build a physician owned facility a little south of me. They were looking for investors from all the subspecialties to assist in the construction of a unique health care facility that would be postioned to compete for those patients located between the giant Cleveland behemoths and the hospitals in Akron. For the most part, it would be entirely physican owned, with the internists/primary care docs getting in on the ground floor. It sounded interesting, I had to admit. But then I came across an article in the NY Times today that made me pause.

Apparently, there has been a steady, driving force from Democratic circles (Hi Pete Stark!) over the years to restrict the existence of physician owned facilities. The assumption is that when doctors own a hospital, they will order more unnecessary tests and procedures because there exists a financial incentive to do so. In other words, you can't trust those unscrupulous docs in such ethical dilemmas. Now I understand that not all physicians are angels sent down from the Mount. Think of the orthopedic guy who buys an MRI for his office and next thing you know, everybody in town gets magnetized. Or the General surgeon who buys an ultrasound machine and basically does a full body exam (breast and thyroid ultrasounds included) on all office consults (even when the patient is sent over for a hemorrhoid). Or the family practice doc who has his own lab and ends up ordering twice as much blood work as the guy down the street.

I'm not naive enough to think this doesn't happen. Doing the right thing for the patient always takes precedence over any financial gain. But at the same time, isn't this a market driven, capitalistic country? Just playing the devil's advocate, but why should physicians be excluded from playing the game? Or a better question: what drives physicians to feel the need to play such a game? And what if the doctor who buys his own ultrasound uses it justifiably? Like only when a patient comes in for a breast mass or a thyroid nodule? Why shouldn't he be able to bill for expertise in using a specialized instrument? Why should he have to send the patient off to the radiologist for an ultrasound that may be more expensive, and certainly wastes time? If you don't trust him, create a way to audit his billing records; if there is any question a third party arbitrator can determine whether the test is or isn't justified.

I just think the Pete Starks of Washington have it in for us. Once again, it's an attempt to demonize physicians as profiteers looking to wring everything they can out of the system. As if we are the source of the profligate waste of our country's health care dollars. Of course, as long as your local democratic politician (I mean you, Patty Murray!) is on your side, there is always the chance a "special dispensation" will get written into the law...

Here's the problem, as I see it...and in doing so I will answer a rhetorical question (sorry). You asked: "...at the same time, isn't this a market driven, capitalistic country?" Well, sort of. The problem is that we have a quasi-capitalistic medical system (and country). The government thinks it has a right to stick its nose into our business because 'they' are footing the bill (with our $$, of course).

The only (and I repeat ONLY) way to ever get out from under the government's heavy thumb is to be financially independent. So long as they dictate the terms of Medicaid/Medicare, and those programs fund an essential portion of our expenses, we will have to live with their decisions…as long as ‘they’ hold office, that is.

So, it seems that the quickest way to fix the problem is to simply not accept Medicare/Medicare. That will invariably bring charges of cherry-picking only the ‘wealthy’ and all that, but it would solve the immediate problem. A more long-term solution will involve a change in the public’s, and therefore the politician’s, general view of who directly pays for health care delivery in this country.

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